Reasons for Hospitalization among Emergency Department Patients with Syncope

Abstract

Background

Variations in syncope management exist. Our objective was to identify the reasons for consultations and hospitalizations, and outcomes among ED syncope patients.

Methods

We conducted a prospective cohort study to enroll adult syncope patients at five emergency departments (EDs). We collected baseline characteristics, reasons for consultation and hospitalization, and hospital length of stay. Adjudicated 30-day serious adverse events (SAEs) including death, myocardial infarction, arrhythmia, structural heart disease, pulmonary embolism, significant hemorrhage and procedural intervention. We used descriptive analysis.

Results

From 4,064 enrolled patients (mean age 53.1 years, 55.9% female), 3,255 (80.1%) were discharged directly by the ED physician. Of those with no SAE identified in the ED (n=600): 42.8% of referrals and 46.5% of hospitalizations were for suspected arrhythmias; 71.2% of patients hospitalized for arrhythmias had no cause identified. SAE among groups were 9.7% in total; 2.5% discharged by ED physician; 3.4% discharged by consultant; 21.7% as inpatient and 4.8% following discharge from hospital. The median hospital length of stay for suspected arrhythmias was 5 days (Interquartile range 3 – 8 days).

Conclusion

Cardiac syncope, particularly suspected arrhythmia, was the major reason for ED referrals and hospitalization. The majority of patients hospitalized for cardiac monitoring had no identified cause. An important number of patients suffered SAE, particularly arrhythmias, outside the hospital. Development of a risk-stratification tool and out-of-hopsital cardiac monitoring strategy should improve patient safety and save substantial resources.

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